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Acute Mesenteric Ischemia: Vascular Emergency

Time-critical bowel ischemia from sudden compromise of mesenteric circulation requiring rapid revascularization

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Acute Mesenteric Ischemia: Vascular Emergency?

Acute mesenteric ischemia is interruption of intestinal blood flow leading to bowel infarction, with mortality rates 50-80% if treatment is delayed beyond 12-24 hours.

Etiologies include arterial embolism (40-50%, often cardiac source), arterial thrombosis (20-30%, atherosclerotic), venous thrombosis (10%, hypercoagulable states), and non-occlusive (NOMI, 20%, low-flow states).

The hallmark clinical feature is severe pain disproportionate to physical findings; classic signs of peritonitis appear late, after transmural infarction.

CT angiography of the mesenteric vessels is the gold-standard diagnostic test and should be obtained without delay in any suspected case.

Symptoms

Sudden onset of severe diffuse or peri-umbilical abdominal pain disproportionate to physical findings
Nausea, vomiting, watery or bloody diarrhea
Atrial fibrillation or other cardiac arrhythmia in embolic disease
Postprandial pain history in chronic-on-acute thrombotic disease
Late signs: peritonitis, distension, hypotension, sepsis, lactic acidosis

Risk Factors

Atrial fibrillation, recent myocardial infarction, valvular disease (embolic source)
Atherosclerotic disease, prior peripheral arterial disease, smoking
Hypercoagulable states (Factor V Leiden, antiphospholipid syndrome) for venous thrombosis
Critical illness, vasopressor use, dehydration, dialysis (NOMI)
Advanced age, abdominal malignancy, prior abdominal surgery

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Call emergency services (112) for any sudden severe abdominal pain, especially in patients with atrial fibrillation or cardiac risk factors
  • Apply for urgent care if abdominal pain is accompanied by bloody stool, vomiting, and disproportionate findings on examination
  • Suspect mesenteric ischemia in elderly patients with postprandial pain and weight loss progressing to acute pain
  • Re-evaluate any post-cardiac surgery, post-cardiac arrest, or critically ill patient with new abdominal symptoms

Treatment Methods

01
Immediate resuscitation with intravenous fluids, broad-spectrum antibiotics, nasogastric decompression, and correction of acidosis
02
Therapeutic anticoagulation (heparin) for arterial and venous thromboembolic disease
03
Endovascular revascularization (mechanical thrombectomy, aspiration, stenting) is increasingly first-line for many cases
04
Open surgical embolectomy or bypass with concurrent laparotomy to assess bowel viability and resect non-viable segments
05
Second-look laparotomy in 24-48 hours to reassess marginal bowel viability; long-term anticoagulation and aggressive cardiovascular risk modification

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.